Presentation (CTI)

OBJECTIVES: Bloodstream infections (BSI) are associated with a high risk of in-hospital mortality. While clinical factors play a critical role, social drivers of health (SDoH) also contribute to disparities in mortality risk. This study aimed to evaluate the association between selected SDoH and in-hospital mortality among patients hospitalized with BSI.
METHODS: Using the Premier PINC AI™ Healthcare Database, this retrospective cohort study included adult patients (≥18 years) hospitalized with BSI and discharged between January 1, 2017, and December 31, 2018. SDoH assessed included patient demographics (age, sex, race, ethnicity), insurance type, and social vulnerability index (SVI). Multivariable logistic regression analyses were conducted to evaluate associations between these SDoH and in-hospital mortality.
RESULTS: A total of 279,680 patients with BSI were identified, with an in-hospital mortality rate of 9.3%. Older age was associated with increased risk of in-hospital mortality. Patients with Medicaid or no insurance (uninsured) had 20% and 25% higher odds of in-hospital mortality, respectively, compared to those with commercial insurance after adjusting for confounders (Adjusted Odds Ratio (OR) for Medicaid: 1.20 [95% Confidence Interval (CI): 1.13-1.27]; uninsured: 1.25 [1.15-1.35]). Among patients aged 65 and older, Medicare was associated with a 12% higher risk of in-hospital mortality (Adjusted OR: 1.12 [1.03-1.21]), and uninsured patients had a 74% higher risk compared to those with commercial insurance (Adjusted OR: 1.74 [1.39-2.17]). Additionally, patients in the high SVI group (low socioeconomic status) had a 9% greater risk of in-hospital mortality compared to those in the low SVI group (Adjusted OR: 1.09 [1.06-1.12]).
CONCLUSIONS: Social vulnerability index and having government-funded health insurance or no insurance are significant independent risk factors for in-hospital mortality among BSI patients. These findings underscore that patients with lower socioeconomic status had worse clinical outcomes and emphasize the critical need to address social drivers of health and improve clinical outcomes in this high-risk population.